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Rejoinder 

to  Dr.  Hughes, 


BY  PROSPER  BENDER,  M.D.,  BOSTON,   MASS. 


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A    REJOINDER    TO    DR.    HUGHES. 

BY   PROSPER   RENDER,    M.D.,    BOSTON,    MASS. 

Dear  Dr.  Hughes,  —  The  courteous  letter  which  you  did 
me  the  honor  of  addressing  me  through  the  September  number 
of  "  The  New-England  Medical  Gazette,"  I  have  read  with 
much  interest.  At  the  opening,  you  remark,  with  reference  to 
my  "  Address  "  delivered  before  the  Hahnemannsis  Societas, 
B.  U.S.  M.,  Feb.  9,  1888:  "  I  was  naturally  somewhat  troubled 
at  seeing  students  warned  against  a  mode  of  homceopathizing 
which  you  associate  with  my  name,  and  I  read  on  with  some 
curiosity  to  see  the  grounds  of  your  admonition  ; "  and  you  add 
you  were  not  "a  little  astonished"  to  ascertain  that  in  reality 
you  had  fulfilled  every  requirement  of  the  law  I  had  advocated 
of  practising  according  to  the  totality  of  the  symptoms.  In 
support  of  this  statement  you  cite  the  introduction  to  your 
work  on  "  Therapeutics."  I  am  happy  to  admit  that  in  the 
chapter  mentioned  you  have  fairly  and  ably  vindicated  "  the 
scientific  accuracy  and  practical  adaptability "  of  the  law  of 
siniillimum  ;  but,  as  regards  the  therapeutical  hints  interspersed 
through  the  body  of  the  work,  I  regret  to  have  to  say,  they  seem 
of  a  nature  to  induce  the  investigator  to  adopt  an  "  easy  made," 
simple  system  of  homceopathy,  which  cannot  be  successfully 
practised,  leading  in  many  cases  to  discouragement  and  doubt. 
But  more  of  this  anon. 

To  return  to  your  letter.  You  state  that  "  you  and  I  mean 
something  very  different  by  the  phrase  '  totality  of  symptoms,'  " 
your  view  being  similar  to  Hahnemann's  ;  i.e.,  "  that  the  pa- 
tient's condition  shall  find  as  close  a  reflection  as  possible  in 
the  pathogenetic  effects  of  the  drug."  Now,  I  cannot  imagine 
on  what  grounds  you  hold  this  opinion.  In  the  "  Address " 
under  discussion,  I  particularly  and  emphatically  assert  my  belief 
in  that  law,  repeating  it  more  than  once.  I  acknowledge  I 
alluded  to  the  diflficulties  occasionally  experienced  in  selecting 
the  simillimum  from  an  array  of  symptoms,  but  I  do  not  think 
I  said,  nor  did  I  mean,  that  such  was  "  illusory,"  or  any  thing  of 
that  nature.  I  tried,  however,  to  point  out  to  the  students  ex- 
pedients or  "  short  cuts,"  with  a  view  to  facilitating  the  selection 
of  the  right  remedy,  naming  several,  with  the  careful  reminder 


51499 


at  the  same  time,  to  "  select  a  medicine  which  will  not  only  cover 
single  symptoms  but  the  totality  of  them,"  and  to  "  prescribe 
according  to  the  totality  of  the  symptoms,  whatever  the  name 
of  the  disease"  {vide  "Address").  But,  while  I  believe  in  the 
law  of  similars  as  enunciated  above,  I,  too,  must  assert  that 
"  you  and  I  mean  something  very  different  by  the  phrase  '  total- 
ity of  symptoms,' "  as  I  shall  try  to  show  in  this  letter.  You 
have  correctly  apprehended  the  law  in  the  introductory  chapter 
you  refer  to,  but  you  give  little  evidence  of  its  recognition  or 
influence  in  the  rest  of  your  work. 

In  relation  to  the  therapeutical  rules  which  I  suggested  to 
the  members  of  the  society,  styled  by  you  "  empirical  expedi- 
ents," you  observe :  "  These  indications,  I  say,  are  mostly 
empirical.  There  is  nothing  about  mechanical  injury  in  the 
pathogenesis  of  hypericum,  or  of  a  wetting  in  that  of  rhus. 
The  '  keynotes '  of  Guernsey  and  his  followers  are  only  ex- 
ceptionally to  be  found  among  the  effects  of  the  drug  on  the 
healthy  body.  The  mental  symptoms  of  certain  well-known 
remedies  doubtless  appear  under  their  headings  in  the  pure 
materia  medica,  but  so  they  do  under  those  of  a  hundred  others 
with  which  they  have  never  been  associated.  The  same  may  be 
said  of  the  conditions  ;  and  both  are  so  mixed  up  with  others 
of  opposite  character  as  to  be  practically  neutralized."  In  a 
species  of  happy  second  thought  you  state  in  the  next  para- 
graph, "  Please  do  not  understand  me  to  be  denying  the  value 
of  such  indications.  I  have  dwelt  on  them  all  in  various  places 
in  my  books,  and  use  them  all  in  my  daily  practice.  The  point 
I  am  making  is,  that  they  are  outside  of  homoeopathy  proper." 

I  am  aware  "there  is  nothing  about  mechanical  injury  in  the 
pathogenesis  of  hypericum,  or  of  a  wetting  in  that  of  rhus," 
but  I  am  sure  that  you  will  not  challenge  the  fact  that  the  train 
of  symptoms  in  both  remedies  closely  correspond  with  those 
following  such  factors.  In  the  pathogenesis  of  hypericum  we 
have  most  of  the  symptoms  witnessed  in  injuries  of  the  nervous 
tissues,  and  in  rhus  an  almost  identical  reproduction  of  the 
picture  of  the  case  of  a  person  who  has  been  exposed  to  a 
drenching  rain.  The  provers  of  hypericum,  while  suffering 
from  severe  pains  in  the  spine  and  back,  with  numbness  and 
crawling  in  the  limbs,  felt  exacerbations  from  motion  or  pressure  ; 
the  provers  of  rhus  experienced,  in  addition  to  aching  in  the 
muscles,  stiffness  of  the  joints,  aggravation  during  rest,  and 
relief  from  motion,  and  a  marked  susceptibility  to  atmospheric 
changes  such  as  an  approaching  storm  or  wet  weather.  The 
provers  of  aconite  exhibited,  beside  mental  and  physical  rest- 
lessness and  uneasiness,  decided  susceptibility  to  dry,  cold 
winds;   the   provers  of   ignatia   were  particularly  affected  by 

KX 


worry  or  grief,  and  so  forth.  These  are  well-known  conditions 
following  equally  well-known  causes. 

But  here  is  a  stronger  case  in  point.  When  we  are  called  to 
patients  affected  with  infectious  diseases,  remedies  are  suggested 
by  the  phenomena  present  only  ;  we  do  not  seek  for  drugs  which 
can  produce  the  inateries  morbi  of  those  affections,  since  none  are 
known  to  us.  As  in  the  clinical  cases  quoted  in  the  "  Address," 
we  prescribe  for  the  results  which  we  associate  with  certain  causes. 
To  repeat :  we  know  from  clinical  observation  that  a  person  who 
took  a  wetting  is  likely  to  be  affected  in  the  same  manner  as 
the  one  who  is  proving  rhus  ;  that  the  party  who  meets  with 
an  injury  of  the  spine  suffers  pretty  much  in  the  same  way  as 
the  prover  of  hypericum.  Symptoms  and  conditions  identical 
are  present  in  both  instances.  Hahnemann  himself  trusted  to 
clinical  verifications  when  repeatedly  noted  useful  by  compe- 
tent observers  in  usus  morbis  ;  and  in  the  hands  of  reliable  and 
observant  practitioners  hypericum,  rhus,  and  arnica  have  been 
proved  clinically  effective  in  the  removal  of  the  symptoms  de- 
scribed. This  is  surely  more  than  what  the  lawyers  would 
style /^m^ /<?<:/>  justification.  In  fact,  as  you  are  aware,  some 
of  the  most  reliable  symptoms  in  our  materia  medica  are  of 
clinical  origin. 

On  the  subject  of  "  characteristics,"  or  "  keynotes,"  Hahne- 
mann expresses  himself  thus  (section  153):  "This  search  for  a 
homoeopathic  specific  remedy  consists  in  the  comparison  of  the 
totality  of  the  symptoms  of  the  natural  disease  with  the  lists  of 
symptoms  of  our  tested  drugs,  among  which  a  morbific  potency 
is  to  be  found,  corresponding  in  similitude  with  the  disease 
to  be  cured.  In  making  this  comparison,  the  more  prominent, 
tmcommoH,  and  peculiar  (characteristic)  features  of  the  case 
(102)  are  especially,  and  almost  exclusively,  considered  and 
noted  ;  for  these  in  particular  should  bear  the  closest  similitude  to 
the  symptoms  of  the  desired  medicine,  if  that  is  to  accomplish 
the  cure.  The  more  general  and  indefinite  symptoms,  such  as 
want  of  appetite,  headache,  weakness,  restless  sleep,  distress, 
etc.,  unless  more  clearly  defined,  deserve  but  little  notice  on  ac- 
count of  their  vagueness,  and  also  because  generalities  of  this 
kind  are  common  to  every  disease  and  to  almost  every  drug." 
On  this  point,  I  have  taught  the  students  in  the  clinics,  there 
may  be  marked  similarity  in  the  general  effects  of  several  rem- 
edies, but  each  has  a  distinctive  characteristic  by  which  it  may 
be  individualized  and  set  aside  from  any  other.  In  disease,  I 
counselled,  endeavor  to  single  out  the  characteristic  symptom, 
and  then  find  a  remedy  which  has  a  similar  symptom  in  its 
pathogenesis,  when  generally  it  will  be  seen  that  the  other 
symptoms  correspond  with  it.     The  law  of  relationship  of  cura- 


tives  to  disease  is  based  on  these  characteristics  ;  around  them 
the  minor  symptoms  cluster  or  harmonize,  and  thus  make  a 
tout  ensemble.  No  Hahnemannian  contends  he  can  prescribe 
exclusively  upon  any  "  keynote."  All  the  symptoms  taken  col- 
lectively are  necessary,  giving,  however,  especial  prominence 
to  some. 

The  experience  of  many  brother  practitioners  also  corresponds 
with  my  own  as  to  the  great  value  of  the  mental  symptoms,  often 
directing  us  to  the  right  remedy.  A  physician  who  is  not 
acute  may  not  readily  distinguish  between  the  mental  condi- 
tions of  aeon.,  ars.,  chamo.,  coffea,  nux,  puis.,  etc.  ;  but  to  the 
observant  they  are  as  distinct  as  day  is  from  night,  and  they 
prove  the  rational  guide  to  the  proper  remedy.  You  remark 
towards  the  end  of  your  letter,  that  what  "the  patient  desires 
to  be  rid  of  is  his  malady  :  ...  it  is  not  the  peculiar  way  in 
which  this  may  affect  his  nerves."  But,  my  dear  doctor,  you 
will  hardly  dispute  the  fact  that  it  is  the  state  of  his  nerves, 
as  expressed  by  his  symptoms,  which  best  indicates  the  remedy 
to  be  given. 

I  believe  the  neglect  of  the  conditions  you  so  little  value, 
often  results  in  failure  to  cure.  I  think  them  only  less  im- 
portant than  the  mental  state.  Hahnemann  gave  both  great 
consideration  and  prominence.  The  aggravation  by  motion  or 
rest  is  one  of  the  leadmg  factors  in  the  pursuit  for  the  simi- 
lar in  rheumatism  ;  and  the  effects  of  the  weather  in  certain 
mental  states  will  often  help  us  to  secure  the  fitting  remedy. 
With  rgard  to  symptoms  in  their  relation  to  time,  is  not  the 
hour  when  the  chill  in  intermittent  fever  appears,  one  of  the 
main  indications  .^  Is  not  the  hour  of  the  return  of  pain  in 
neuralgia,  or  the  paroxysm  of  cough  in  phthisis,  or  the  spasm 
in  asthma,  a  valuable  guide  in  the  selection  of  the  remedy .-'  I 
would  like  to  enlarge  on  this  subject,  but  out  of  regard  for  the 
Gazette's  space  I  refrain.  I  must,  however,  repeat,  unless  we 
closely  individualize  the  symptoms  of  the  case,  the  curative 
specific  will  elude  our  grasp,  when  the  patient  may  either  slip 
through  our  hands  to  join  the  "  majority,"  or  long  elude 
our  skill. 

Now,  with  your  permission,  I  will  give  my  reasons  for  the 
statement  in  the  "  Address,"  that  your  "recommendations  often 
proved  disappointing,"  although  I  admitted  that  through  their 
aid  I  not  seldom  made  "  a  brilliant  cure,  but  oftener,  when  mov- 
ing solely  by  these  lights,  failure  occurred."  I  shall  here  illus- 
trate some  of  the  perplexities  which  may  arise  from  a  sole 
dependence  upon  your  Manual.  Let  us  suppose  that  I  have  a 
case  (I  take  a  subject  at  hap-hazard)  of  vicarious  menstruation. 
Under  that  heading,  I  find  in  your  volume  on  "  Therapeutics," 


p.  408  :  "  Dr.  Leadam  recommends  ferrum,  and  Dr.  Carroll  Dun- 
ham bryonia,  as  the  most  .suitable ;  hamamelis  also  has  occasion- 
ally effected  this  purpose."  Both  these  gentlemen  take  high 
rank  as  able  physicians  and  authors  in  their  respective  countries. 
If  I  were  an  Englishman,  I  would  likely  give  ferrum  ;  if  an 
American,  bryonia.  I  may  or  may  not  hit  off  the  case  with 
either,  depending  upon,  if  I  have  accidentally  struck  an  appro- 
priate case,  where  one  or  the  other  remedy  is  called  for.  If  I 
fail  with  both,  I  naturally  resort  to  hamamelis  ;  but  here  again 
I  may  be  disappointed,  for  that  particular  case  may  demand  a 
totally  different  remedy.  What  follows  such  a  groping  about  in 
prescribing  }  Is  one  not  likely  to  become  disgusted,  and  throw 
homoeopathy  aside,  as  having  been  tried  and  found  wanting .-" 

The  Hahnemannian  proceeds  very  differently.  He  consults 
all  the  symptoms  of  the  case,  the  conditions,  concomitants,  and 
so  forth  ;  and  when  he  has  finally  decided  upon  a  remedy,  pre- 
vious experience  justifies  him  in  expecting  that  it  will  act 
satisfactorily.  If  the  pulse  be  irritable,  blood  flowing  from  the 
nose,  dark  and  clotty,  in  a  patient  with  cold  hands  and  feet,  who 
is  easily  fatigued  and  flushes  from  the  least  excitement,  he  gives 
ferrum  ;  if,  on  the  other  hand,  she  belongs  to  the  bilio-lymphatic 
temperament,  inclined  to  be  irritable,  the  blood  brown,  the  dis- 
charge starting  or  increasing  by  motion,  he  administers  bryonia ; 
if,  again,  the  blood  be  dark,  venous-looking,  flowing  passively, 
varicose  veins  of  legs,  with  relief  of  the  pain  in  the  forehead 
from  the  flow,  he  orders  hamamelis.  But  the  subject  may  call 
for  puis,  instead ;  blood  alternately  pale  and  dark,  chilliness  in- 
doors, with  sense  of  suffocation,  relieved  in  the  open  air,  the 
emotional  faculties  so  affected  that  the  least  thing  will  cause 
weeping  ;  or  perhaps  bell.,  with  its  hot  red  blood,  congested 
face,  drowsiness  but  inability  to  sleep,  etc. ;  in  point  of  fact,  any 
remedy  in  the  materia  medica  may  be  the  simillhnmn.  You 
may  say,  however,  "the  investigator  should  consult  at  the  same 
time  my  work  on  Pharmacodynamics."  But  here  also  he  may  find 
himself  stranded,  for  under  the  above  remedies  there  is  hardly 
any  better  "  precisionizing  "  in  the  manner  of  a  Hahnemannian. 
The  same  objections  might  be  urged  against  many  other  equally 
vague  prescriptions  of  yours,  but  enough  on  this  subject  for  the 
present. 

In  truth,  dear  Dr.  Hughes,  you  have  sought  to  give  your 
readers  an  easy  system  of  homoeopathy ;  a  dependence  upon 
which  will  frequently  lead  to  professional  failure.  Your  system 
is,  in  a  measure,  the  old-school  generalization,  exempting  one 
from  the  laborious  method  of  the  differentiating  of  the  elements 
of  the  case  and  of  drug-action.  You  overlook  the  subjective 
symptoms,   the    modalities,   conditions,  etc.,   which    generally 


enable  the  Hahnemannian  to  prescribe  successfully.  You  seem 
to  consider  all  the  symptoms  of  a  given  case  as  a  whole,  to  be 
treated  as  such.  Now,  the  simple  name  of  a  disease  does  not 
help  the  healer  in  the  solution  of  the  problem  of  the  best 
remedy  ;  it  is  the  phenomena  presenting  themselves.'  Nor  does 
the  fact  of  a  certain  remedy  having  once  proved  useful,  afford 
any  particular  aid  in  the  bulk  of  the  cases  bearing  a  generic 
resemblance  to  that  disease  ;  a  correct  decision  being  obstructed, 
not  seldom,  by  the  varying  decisions  of  perhaps  a  dozen  author- 
ities on  the  subject. 

I  have  found  it  "illusory"  in  practice  to  base  my  selection  of 
a  remedy  upon  pathological  conditions,  or,  in  other  words,  to 
select  a  drug  because  known  to  affect  one  particular  organ, 
which  I  suspect  to  be  affected,  unless  I  have  positive  evidence 
of  a  disturbed  balance  in  its  functions,  as  manifested  by  pain, 
etc.  We  must  choose  a  remedy  capable  of  modifying  the 
healthy  functions  in  the  same  manner  as  the  malady  does  ; 
including  characteristics,  conditions,  concomitants,  and  so  forth. 
When  the  pathological  conditions  and  symptomatic  indications 
are  in  clear  relation  to  each  other,  the  case  is  easy  and  simple  ; 
but  often  you  cannot  recognize  any  distinct  pathological  state, 
and  then  your  location  of  the  seat  of  disease  must  be  a  simple 
surmise.  Under  such  circumstances,  the  prescription  of  the 
adherent  of  the  pathological  school  must  be  problematical  in  its 
effect.  Daily  experience  teaches  me  that  the  strict  inductive 
method  of  Hahnemann  is  the  only  safe  and  rehable  one.^ 

No  physician  can  be  successful  who  is  not  familiar  with  the 
laws  of  life  in  disease  and  in  health,  and  the  means  of  maintain- 
ing the  latter  and  correctihg  the  former.  Disease  is  many- 
sided,  and  should  be  studied  in  all  its  phases,  as  well  as  the 
manner  in  which  remedies  are  capable  of  modifying  the  healthy 
functions  of  the  human  body.  I  yield  to  none  in  recognizing 
the  importance  and  utility  of  pathology  and  diagnosis  in  their 
clinical  bearing :  a  complete  knowledge  of  disease,  its  causes, 
course,  duration,  morbid  anatomy,  and  ultimate  issue,  being 
essential  to  success  in  the  practice  of  medicine.  But  in  sum- 
ming up  a  case  with  the  view  of  prescribing,  we  must  include 
all  the  symptoms,  subjective  and  objective,  with  their  conditions. 


■  p.  p.  Wells  truly  says,  "The  modern  resort  to  generalization  in  pretended  homcEo- 
pathic  practice  and  teaching,  is  ever  an  exclusion  of  all  which  is  essential  to  the  philosophy 
of  the  natural  law  of  therapeutics." 

'  Dr.  Carroll  Dunham,  in  speaking  of  pathology  as  a  basis  of  treatment,  says,  "  The 
endeavor  can  never  be  successful,  inasmuch  as  the  mnction  of  pathology  is  to  furnish  not  an 
indication  for  medical  treatment,  but  simply  a  means  of  elucidating  and  collating  the  symp- 
toms. The  result  has  been  a  sad  falling-off  from  the  standard  of  success  in  practice,  which 
was  established  by  Hahnemann  and  his  pupils."  He  also  states  elsewhere,  "  Success  in  treat- 
ment, based  upon  a  pathological  consideration  of  the  case,  must  depend  on  the  correction  .of 
the  pathological  hypothesis,  a  matter  in  which  certainty  can  never  be  attained." 


etc.  If  these  be  excluded  from  the  picture,  an  imperfect  selec 
tion  is  most  likely  made.  The  symptoms  by  which  we  diagno.sc 
a  disease  are  often  of  little  or  no  assistance :  it  is  the  symptoms 
which  are  peculiar  or  unusual,  and  not  those  belonging  ordi- 
narily to  thf*  diseased  organ,  which  should  take  precedence. 
These  characteristics  point  to  one  remedy  or  a  group  of  them, 
and  then  the  incidental  manifestations  come  in  as  "clinchers." 

I  began  this  reply  by  a  tribute  to  the  courteous  tone  you 
adopted  in  addressing  me,  and  this,  as  far  as  I  know,  has  been 
characteristic  of  all  your  utterances  in  discussion.  There  is  one 
allusion,  however,  in  the  first  part  of  your  letter  to  me,  which 
marks  something  approaching  an  exception  to  your  usual  deli- 
cacy ;  but  I  suppose  that  haste  or  heedlessness  will  be  the 
explanation.  You  say,  in  referring  to  my  selection  of  ipecac  in 
the  case  of  broncho-pneumonia,  which  I  reported,  that  you  too 
would  have  prescribed  the  same,  and  that  "  without  consulting 
Jahr."  There  is  here  the  suspicion  of  a  reflection  which,  for 
the  sake  of  yourself  as  well  as  my  claims,  I  would  have  pre- 
ferred unwritten.  The  casual  reader  might  infer  that  I  was  not 
conversant,  at  the  time  I  wrote,  with  the  symptomatology  of 
ipecac,  whereas  in  the  "Address"  I  stated  the  related  incident 
occurred  "  when  I  began  the  study  of  homoeopathy,"  some  few 
years  after  I  graduated  (in  1865).  At  a  similar  stage  of  your 
own  homoeopathic  professional  experience,  it  is  quite  possible 
that  you  yourself  might  have  been  obliged  to  refer  to  some 
authority  on  the  subject. 

I  cordially  recognize  that  you  have  presented  to  our  English 
confreres  a  method  of  practising  homoeopathy,  which,  by  its 
simplicity,  enforced  by  a  felicitous  aiction  and  unusual  lucidity, 
immediately  commanded  their  respectful  attention  and  approba- 
tion ;  but  candor  compels  me  to  add  that  those  who  will  adhere 
to  your  method  will  not  prove  the  best  exponents  or  most  suc- 
cessful practitioners  of  our  school.  When  I  prescribed  by  such 
aids  as  you  present,  I  felt  less  confidence  in  my  prescriptions 
than  after  I  had  adopted  the  Hahnemannian  system.  Now,  when 
I  have  found  a  remedy  whose  record  corresponds  closely  with 
that  of  the  sick  phenomena,  I  am  satisfied  that  my  services 
will  prove  profitable  to  the  patient.  I  admit  the  study  of  whole 
columns  of  symptoms  is  a  laborious  task,  but  the  reward  and 
satisfaction  it  generally  yields  constitute  a  sufficient  recom- 
pense to  the  conscientious  physician. 

In  conclusion  let  me  say,  I  have  thought  it  my  duty  to  notice 
every  point  you  made,  and  refute  it,  if  able,  for  the  sake  of  the 
cause  we  both  have  at  heart,  even  if  di^ering  in  some  respects 
in  its  practice.  I  hbpJ&JI'hayjB*\s^bJYii:jiiy*apptr&ciation  of  your 
spirit  of  candor  and:  e&r6i^tnds*s.4nlrftv36wiiigray  humble  article ; 


•  •   •  •  •  • 


•  •<•••*    '  •••    ••      ; 


8 

but  I  have  too  high  an  opinion  of  your  character  and  qualifica- 
tions as  an  able,  learned  author,  as  well  as  an  experienced, 
zealous  physician,  to  imagine  that  you  would  shrink  from  a  full, 
sincere  expression  of  my  mind  on  subjects  and  courses  not  only 
highly  interesting  to  our  profession,  but  deeply  concerning  that 
vast  and  rapidly  increasing  multitude,  in  all  civilized  nations, 
whose  confidence  and  highest  temporal  interests  are  so  closely 
bound  up  with  the  great  and  beneficent  system  of  homoeopathy. 
I  am,  dear  Dr.  Hughes, 

Faithfully  yours. 

Prosper  Bender. 

134  BoYLSTON  St.,  Boston,  Mass., 

Sept.  30,  1888. 


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